CUE–THE QUINTESSENTIAL ELEMENTS

download (1)Clear and Unmistakable Error, or CUE, is one of the most misunderstood, misconstrued, miscombobulated legal concepts for Veterans to absorb. The idea of reaching back into the past to right a wrong is a wonderful thing we enjoy. As long as you understand this is going to be a knife fight in a dark alley and somebody’s feelings are going to get hurt, you jump in thinking justice can be attained. Nothing could be farther from the truth. 

CUE must be blatant. CUE must be visible from across the room. People from all walks of life should be able to look at it and exclaim “Lookey, Bob. Take a good, long gander here. Thet there’s CUE. See thet?” CUE must also pass other tests which I will expound upon but I want to give you a feel for how it gets misconstrued by many and much judicial time is wasted dedicated to fruitless endeavors.

CUE rules are very simple in VA jurisprudence but as we will notice, the VA’s published standard and their actual tape measure, are far different. VA will indulge in the famous “bait and switch” using smoke for camo to deflect the CUE into the wrong legal argument. You’re busy trying to engage them in a discussion about how you got screwed on the rating in 1986 when you should be arguing about the error in the prior denial in 1982 where the real CUE began. VA is not going to point out the legal flaw for you either.

download (3)This is no-holds barred litigation. Nonadversarial  went out the window with Benefit of the Doubt and a Veteran friendly environment in which to present your claim. A CUE claim is Perry Mason calling Hamilton Burger a chowderhead who isn’t familiar with the LA penal code- and probably never will be.

Many have talked of CUE but the essence is never quite captured.  Let me attempt to shine a light that dispels what it isn’t first. Many Vets come to me and show me evidence that clearly refutes what happened in, say, 1986. Okay. Move to the next disqualifier. Was this evidence part of the record in 1986? Good. Was it open to two different, equally compelling theories, either of which could have been correct?  Yep. Then you lose. You can’t come back for a do over and argue how the facts were decided. This is perhaps one of the hardest legal concepts to learn. It has to be a Holy Shit, Batman-epiphany error. Reasonable minds can concur that, but for that one (or more) error(s), a completely different “butterfly” line of history would have happened.

Was it a diagnosis that said acute in 1986? A later diagnosis, not part of the records, saying chronic now refutes it. Yep. You lose. A newer diagnosis that states it was chronic back when you filed was not part of the record in 1986 and cannot be introduced in evidence. The Motion to Revise (CUE) must be based on the 1986 facts in the Evidence of Record (EOR)  or what we call your c-file. You cannot use newer CAVC or Federal Circuit  Court precedence to win with either. Your whole legal argument must rest on established law in effect at the time of your decision.

Did they ignore the rules and regulations? Yes? Was it due to a misinterpretation of the earlier regulations which was subsequently corrected such as Walker v. Shinseki and the correct interpretation of 38 CFR §3.303(b) was finally interpreted the proper way? Yep. You lose. Just because you won in 1986 based on flawed law doesn’t mean VA can’t come back and “fix” it. They “fix” Vet’s ratings all the time based on CUE. Your only defense in these situations relies on a twenty year rating. Once you have that, VA cannot rescind it regardless of the current law unless you obtained it by fraud.

Did they forget to go get your medical records at Mt. Altoona Community Hospital when you filed in 86? You filled out and signed the Form 21-4142 authorizing them to obtain the records but a search of your c-file does not reveal them. Failure to assist. You get a do over, right? Nope. You lose. The duty to assist was taken off the table after Russell v. Derwinski. Read Caffrey v. Brown . Seems what we call a failure in the duty to assist has to be detected and objected to before it’s final. This falls into the category of ‘An incomplete record is not an incorrect record”.

You’re the lucky Vet and you have all the correct stuff to prove CUE and it gets down to the last test. But for the error, had it not been made, would there have manifestly been a major, different outcome? This is the Claymore mine most Vets hit the wire on. Unless it cannot even be proven otherwise that a different outcome would positively have (not might have, could have, possibly, mighty sure or My Uncle Clem won on that) ensued and you would have prevailed, you lose. The outcome must be undebatable. You have to have the photo finish picture to prove it, too.

A classic example of what isn’t CUE is you win a claim and they gave you 20%. You come back five years later and ask for an increase and they give you 60%. You say you should have gotten that at the beginning. Tough luck. You lose. You had an opportunity to pitch a bitch back then but hey-you settled for it. No Indian giver stuff now, hoss.

downloadImagine a Chutes and Ladders game where all the chutes head to the basement and denial. All the rungs of the ladders are broken or missing, too. And the spinner’s loaded. Welcome to CUE jurisprudence.

To prove CUE, you have to have an indisputable fact, buttressed by law current at the time. The indisputable fact must be so overwhelmingly obvious that it would seem almost impossible to not see it. This may be why it’s so hard to win given the relative density of VA’s raters.

VA is extremely loathe to air their dirty laundry. When they make a mistake of epic proportions like CUE, absent any back pressure, don’t expect them to be self-starters and motivated to correct it.

I just finished what may be my final appeal to VA to correct a major error. To make a long story very short, I had a C&P exam July 18th, 2008. The doctor worked for QTC and was a production line type. He reviewed my skin for Porphyria Cutanea Tarda damage, both current and from the past, annotated I got regular phlebotomies once a month to control it and stated (incorrectly) that more than 6 square inches of exposed skin was not involved. However, in the diagnosis and effects on living, he said I was totally disabled. VA proceeded to award me 10% for phlebotomies. When I filed a NOD for DRO review, they upped it to 40% for the phlebotomies but took back the 10%.

Here’s the C&P exam. Click on it to magnify  for reading.

2014-05-02 2250572014-05-02 225443

At first, I only perceived the 10% takeback as the CUE. After rereading the C&P exam, it was clear that I should have been awarded a full 100% from the get go. I had fallen into VA’s trap. They proceeded to make it a strawman argument over the recission of the 10%. The very last thing they wanted to relitigate was 100% versus 40%, or even 10%.  I suspect they never really looked at page two of the C&P exam where the real rating language was. Instead they “top sheeted” it and spotted the phlebotomies and the skin language.

THE PRESUMPTION OF STUPIDITY

Therefore we are back in court as it were. Being pro se, Veterans are accorded the Presumption of Stupidity and allowed to bumble around quite a bit more than if we had legal minders. This is why I can go back and change the particulars of my CUE insinuation. Yes. It’s still CUE but it occurred October 1, 2008, not March 29, 2010. If you were represented by an attorney, VA would forbid this puddle- jumping from theory to theory. Fortunately for us, many chuckleheads have done what I’m doing as it finally dawns on us that VA screws everything up from the get go.  I filed my Motion to Revise based on what I perceived as error. After more investigation, I unraveled it and corrected, or fine-tuned my argument in my NOD. If I find other compelling legal epiphanies on appeal at the BVA, I am entitled to present them as well up until they make their decision. This bugs them no end, I assure you. Pro se Vets are a pill. Fortunately for us, even if we are represented by a mentally challenged service officer from a major VSO, the Courts still view them as legalzoom.com-i.e. a poor substitute for a real attorney with a Juris Doctor after his name.

First, the October 10, 2011  filing which they lost. I refiled it again on August 12th, 2012. This is why you always use the green card on the major filings.

PCT 10% CUE 10-11

Then the denial of the Motion to Revise. I expected to lose. 85% of us do so on the first trip out. Almost 100% do on CUE filings. No anomalies here:

PCT denial sanitized

Then read the enclosed NOD which rebuts their bait and switch refusal to recognize CUE in this claim. Use VA’s laws against them. If they hang you with a regulation, use it to hang them right back with. The Presumption of Regularity is going to be one of our most potent tools in the future in this respect. Every time you turn around, VA is trying to extend this philosophy into decisions. ‘VA examiner is presumed to know his head from his ass, therefore…’  ‘The IME/IMO was probative and the doctor was presumed to be knowledgeable about HCV even though he was a podiatrist…’ Hey, you guys know the drill.

Redacted NOD CUE PCT 4-22-14 pdf

The important thing to keep in perspective is that VA is going to purposefully pretend they were born yesterday (at night) and are clueless. There will be a brief summary of the evidence and then a hard-charging denial that knocks all the underpinnings out of the argument. Unfortunately it’s  often all wasted effort on the wrong legal standard or precept. When they are finally brought to bear on the correct facts, the argument becomes much more amenable to arbitration. I have known them to continue to evade the real premise which is why you want to iterate it over and over to the point of redundancy and painful boredom. LawBob Squarepants taught me that one.

Proving CUE based on a nebulous theory that is built on a lot of “could haves” and “it seemed to me at the time that” will never prevail. When you allege CUE, it’s akin to calling someone a child molester. You had better have the evidence if you want to be believed. Here, the evidence has to be part of the EOR and subject to only one logical explanation. If you need to do a PowerPoint Presentation, chances are your Motion isn’t going get airborne. Read Fugo v. Brown to get a better idea of the legal requirements.

CUE is initially a two- pronged fork where either one of the elements is enough to prevail. Having passed that test, the “manifestly change the outcome” is the third and final pass/fail. Far too many of us make our cases and then fall flat like a souffle when it comes time to prove the outcome would be different. That is why you have to lay the foundation for it back in Phase one of the CUE elements.

Never proceed into a CUE by dividing the elements up into pieces. This legal action requires lego-like precision. Each part must fit together like it grew there. The ankle bone’s connected to the … knee bone and the knee bone’s connected to the …. thigh bone.  When all is said and connected, it’s like a chain link fence perfectly woven together. Each fact is indisputable. Each decision they made is legally indefensible because the preliminary precept was faulty. Identify that first mistake that set all the other dominoes in motion and you have the winning ticket that manifestly changes the outcome.

Old decisions have many errors. VA and especially the BVA, felt they were a law unto themselves before the Veterans Justice Reform Act (VJRA) was instituted by Congress in 1988. Unfortunately, they continued in that vein for years and years. The Court has spent an inordinate amount of time curbing their errant tendencies. To say they are wiser and don’t make mistakes now is hogwash. They are an insurance company. They deny. Legally or any other way- but they deny. This we know.

CUE is just one area where VA feels Veterans don’t belong. It’s messy and time consuming. It opens old defective practices and decision-making that reveals unmitigated bias and indifference to the Vet’s plight. It shows VA for their true colors- colors they would much rather keep out of sight. The brouhaha at the Phoenix VAMC will just be the tip of the iceberg of VA misfeasance, too. You can expect that to metastasize to other VAMCs soon. It’s systemic and not unique to Phoenix. A trick that good would be shared with other VAMCs. You can bet on it.

Hopefully this helps some of you on your decision-making regarding CUE. It is definitely not for FNGs to the claims world. It is something that must be held up to inspection for hours and days to get the perfect perspective and argument. Augment the error with regulations that either forbid or do not support the error. Illustrate all the other possible permutations such as two views of the evidence and discount them to remove it from the argument. Strip the old decision down to it’s bare bones to show why it would have been different if the correct facts were looked at or perhaps to show that they were not looked at in the correct legal light.

download (2)A CUE claim, correctly constructed, could be delivered and argued by Mojo, Homer Simpson’s trained chimp. It’s a complete, stand-alone argument that is indisputable. After reading it, there can be no discussion of merits or faults pro or con. Either it’s wrong or it isn’t. If you make the case airtight, you win.  For some reason, few of us do. Either that or we all are just overly litigious and like to torture VA.

P.S.

The great news is the VA admitted defeat in 2016, I was awarded the 100% for Porphyria all the way back to 1994 with SMC at the “S” Rate. Cool beans. Win or Die.

Posted in CUE, Nexus Information, Porphyria Cutanea Tarda | Tagged , , , , , , , , , , | 53 Comments

The phenomenon of HIV Bug chasers, Gift Givers (Gifters), and the implication for the blood supply

hivThe American Press Association recently dropped the word “homophobia” from its style book for journalists so writers can now address gay-sensitive topics without being accused of hatred or insanity. The FDA is considering whether to allow gay men to donate blood in the future.  The current MSM deferral policy is stated here.  The agency has received pressure from certain Congressmen and the American Medical Association to reverse the gay blood ban, which they consider discriminatory. This might remind some of the shameful days when blood donations were segregated as white or black.  But today the issue is about statistics and the limitations of HIV screening which the FDA states is not 100% accurate.

 Groups like the American Red Cross depend on behavioral self-reporting by donors. Inviting gay men, even monogamous ones, to donate blood is a bad idea for the public blood supply because their partners may cheat.  Unfortunately, the safe sex/movement has been a failure in the gay community according to newsources.  Most MSMs prefer and practice barebacking (BB/unprotected anal sex) whether they are tops or bottoms.  One destructive gay subculture connecting online and meeting up are Bug chasers and Gift Givers/breeders/seeders. Bugchasing is slang for people who seek to become infected with HIV.  Gifters are HIV-positive people who are interested infecting bugchasers.  It’s a mutual decision between these participants.

A 6-year old documentary, The Gift, has been posted on Youtube in 6 parts (116+K views) and in full by TransParanormal.  Another documentary filmed in the UK, I Love Being HIV+, has also been posted on Youtube. A short creative 15-minute film called Chaser has been posted by the producer, Sal Bardo. on Youtube.  The protagonist goes to a bareback party and is told, “No condoms, it’s rude.” Chaser has been viewed online by over 32,000 people. People who engage in risky sexual behavior will donate their blood for altruistic, monetary reasons, or even sick reasons. Because the FDA states that screening is not 100% accurate, a small amount of blood-borne pathogens must be entering the blood supply from many sources. Do we want to add a new source known to practice risky sex?

According the VA, 80% of their patients have not been tested for HIV!  Nationally the VA cared for 26,784 veterans with HIV in 2013.  One should not assume risky behavior since they could have been exposed to the virus via transmission modes such as jet injectors and other unsafe injection practices of the past.  But still, homosexuals actively serving in the military should not donate blood either. Learning about bug chasing on Youtube was an emotional experience for me but it is important to know about.  How could anyone want HIV or disrespect themselves by attending a cult-like HIV sex orgies?  Bacchanals have been a part of human history from the beginning but frenzied parties dedicated to a virus god? I haven’t seen or read any evidence that HIV-positive status is a status symbol in the majority of homosexuals.  However, if you know any young gays that you can talk openly with, let them know that you value them and hope that they’ll stay far away from this destructive subculture and treat themselves with dignity instead.  You could save a life. They all know about this craziness but may be surprised that you do. The FDA’s ban is about viruses and blood only and not a negative judgement about persons per se.  I hope the science will trump political correctness with regard to the FDA’s decision about donors.

hiv chart

CDC graphic

2015 Update:  Further research into the issue of blood safety in the United States has led me be reverse my opinion.  Getting HIV or HCV from a blood transfusion is an extremely rare event.  Any healthy person should be encouraged to donate blood regardless of sexual orientation.  There are numerous safeguards in place so I’d urge all people with healthy blood to donate.  The American Legion is one place that organizes drives at their posts so that is one option.

Posted in Guest authors, HCV Health | Tagged , , , , , , , , , | Leave a comment

Cash for your plasma? No, cash for your time!

downloadHow safe from blood-borne pathogens can our blood supply and blood products really be today?  Grifols, a Spanish company, owns about 147 plasma collection centers in the United States. Articles about Talecris (now owned by Grifol) has many centers near the Mexican border. Poor Mexicans sell their blood/plasma once or twice each week to pay their bills. 

This is happening in non-border states too.  In my clippings folder, I found an ad (2011) from Talecris from the JOBS FLYER of a local MN paper.  It looks like they are targeting students for this exchange and they have three collection sites!  Some job. 

  The company states that donors are being paid for their time only.  Sure.  Wink. Wink. 

http://myappointment.talecrisplasma.com/

 

Does the VA buy these blood products? Are all those burning-the-midnight-oil student donors indeed healthy?  I’ve scanned the FDA website to see if these blood businesses are required to screen for Hepatitis E (HEV) yet however I don’t see any current press releases.  Therefore, baby boomers and pregnant women (HCV/HBV status known or unknown) should be careful because it doesn’t matter if they are transfused with truly volunteer blood or paid-for blood given the current lack of HEV screening.

 

Posted in Guest authors, HCV Health, HCV Risks (documented), VA Health Care | Tagged , , , , , , , | 4 Comments

FACEPLACE-REPURPOSING TO DECREASE GLOBAL CLUTTER

10253995_10152325872843376_926807318203381995_nAh, my cousin Denise. What can I say? She has moved to Idaho and the sights to behold there stagger the imagination. I spotted her ultimate doghouse post this morning. Construction like this could only emanate from the fertile mind of a Veteran. Who else would readily see the possibilities of a defunct dryer and it’s future potential?  Using the national flag of Idaho for the roof was a masterful stroke as well.   

Posted in FACE HUMOR | Tagged , , , , , , , | 5 Comments

VAOIG–CAP REVIEW-PHOENIX, AZ

oig

EXECUTIVE SUMMARY

Review Purpose

At the insistence of Rep. Jeff Miller, and prompted by over 1600 complaints of  Veterans waiting over a year and half or longer for primary care followup appointments at the Carl T. Hayden VA Medical Center located in Phoenix, Arizona,  the VA’s Office of Inspector General (OIG)promptly scheduled and performed a CAP Review.  The purpose of the review was also to evaluate selected health care facility operations, focusing on patient care quality and the environment of care, and to provide crime awareness briefings. We conducted the review the same day Representative Miller requested it on April 24, 2014. In fact, we just happened to be there following an earlier phone call from our guy at CNN. Thus we’re able to kill two birds with one stone today.

Review Results

The review covered seven activities. We made no recommendations in the following two activities:

 Coordination of Care

As there is no plan in place to notify patients of the correct date of their appointments, coordination of care was put on hold for a suitable cooling off period to make Veterans forget what it was they were complaining about.

 

 Medication Management
Card-operated machines that dispense medications were installed in the hallway adjacent to the pharmacy’s bulletproof glass windows recently. Veterans with MyHealtheVet or access to Ebenefits can access their medications directly without waiting in line.  OIG’s Quality Control and Assurance Team (QCAT) found a 38 percent error rate with type/dosage of medications machine-dispensed but the VISN director assures us they are on track to reducing it to less than 5 percent by January 1, 2015.

Recommendations

We made recommendations in the following five activities:

 Veterans Dying Waiting for Appointments

We documented forty cases of Veterans dying while waiting for followup care with their Personal Care Physician (PCP)-not the 236 claimed. Due to confusion in scheduling, the deceased Veterans and their spouses were wrongly told to wait until called. This was incorrect advice and resulted in very long wait times that impacted some Veterans permanently. Nurses and frontline stakeholders are scheduled for refresher training in the existing triage protocols to prevent a recurrence of this unfortunate anomaly the week of May 5-9, 2014. Employees were counseled to avoid contact with the media until after training and all the facts are in.

 The Existence of Some “Secret List” for Appointments

In spite of numerous rumors of a secret Bat Cave full of appointments hidden from view, VA’s OIG was unable to substantiate this and found no secret entrances in the basement. A thorough search was conducted, however, and we rounded up the usual suspects.

 Poor Morale Among Medical Staff

VA’s OIG was unable to substantiate that morale was low. They found no one willing to squeal because they didn’t want to lose their jobs. This, too, was third hand hearsay and never substantiated. When interrogated alone individually, all medical employees evoked smiley faces and said they were honored to be employed by the VHA and helping Vets.

 Pressure Ulcer Prevention and Management

A large number of the dead Veterans mentioned above had extensive pressure ulcers (bed sores) indicating poor hygiene and supervision. Supervisors are admonished to continue annotating this information in the records until someone officially declares the Veteran dead.

Accurately document location, stage, risk scale score, and date pressure ulcer acquired for all patients with pressure ulcers. Perform and document daily skin inspections and daily risk scales for patients at risk for or with pressure ulcers. Provide and document pressure ulcer education for patients at risk for and with pressure ulcers and/or their caregivers. Ensure all designated employees receive training on how to administer the pressure ulcer risk scale, how to conduct a complete skin assessment, and how to accurately document findings. Ensure all designated employees receive training on how to identify dead or dying Veterans.

 Allegations of _________________

____________________________________________________________

___________________________________________________(redacted)

Comments

The Interim Veterans Integrated Service Network Director and Facility Director, Sharon Helman,  partially agreed with the Combined Assessment Program review findings and recommendations and provided acceptable answers for improvement plans. She still insists there are no secret records and no Veterans died on her watch. Her feelings were that some Veterans engage in vicarious, risky behaviour to include drug abuse, alcoholism and especially prescription drug abuse. To attribute these deaths to VA’s shortcomings is merely a convenience for survivors to hit the VHA up for money.  She indicated she’ll fight to keep her recent $ 9,345.00 bonus because she was simply following VHA executive orders (See Appendixes C and D, pages 20–26, for the full text of the Directors’ comments.) We will follow up on the planned actions until they are completed.

(signed)

Johnny B. Goode, MD

Assistant Inspector General

for Healthcare Inspections

vaoig

 

Posted in VAOIG Watchdogs | Tagged , , , , , , , , , | 2 Comments

FACE IT–EASTER BUNNY HUMOR

10155422_10152437572269276_3472143893646331807_nIt seems the really good stuff doesn’t surface until the day after Easter. Why not share it sooner? What’s the big deal? Religion? Included here is a rare shot of the Big Guy himself being chased by Chicago’s finest. Seems they thought he had a concealed weapon. My question is where? Between his ears? The basket is in his right hand just outside the photo.

And of course, this was sent in.

1969207_10152313950020700_615299769645856473_n

And this:

10269616_10152313944365700_6484779763028729532_n

I’m sure that’s not all our loyal members have in their repertoire. I look forward to more.

 

Posted in FACE HUMOR | Tagged , , , , , , , | Leave a comment

VA ILP–THE FARM REPORT

2014-04-18 12.15.18Just in case the VA sleeps with one eye open to make sure my agrarian pursuits are not a flash in the pan, I present the Grahamcracker report. I have been busy prepping for spring as usual. This always takes me away from my VA claims work and I apologize. This year will be a banner one for Veterans on the Key Peninsula. I already held a tomato starts sale and thoughtful folks hereabouts donated $99.00 towards that several Sundays ago. Thank you. 

With all the different flowers and fruit trees blooming, I’ve come to the conclusion a resident, on-site bee presence is going to be needed to ensure early spring pollination. I’ll have to add that to the greenhouse request. Hey! Speaking of which. I called the Prize Redemption Line at 800-827-1000 and complained mightily that VA had been funning me about finishing up my ILP request for the Greenhouse. If you remember, the last fiasco was that they claimed I never sent in the Form 9 within the allotted 60 days-thus voiding the Warranty. Well, we here at Asknod don’t get rolled that easily so we promptly whipped out the green card from our USPS and pointed out Clyde Klopperstad signed for it April 15, 2013. A mad search for it began and it was finally located at the BVA in DC in my decision for the 1994 date of claim. That was back in November 2013. Seems some confused fellow in Seattle “accidentally” thought the Form 9 for a ILP greenhouse appeal had something legally in common with Hepatitis C effective dates appeals and thoughtfully forwarded it to the BVA.

The latest is a compendium of “The dog ate the Form 9” followed by “My dear old dad just passed away and I had to take off for that”. No explanation other than the inadvertent revelation that it had actually been sitting on his desk for months while he wrestled with his conscience and the confangled new M-28 Manual for VR&E claims.  Being born and bred a gfentleman, I decided not to call him on the obvious lie about having “lost” the claim for a protracted time if it had been residing on his desk these last months.

As almost no one other than Independent Living Program junkies would know, VA thoughtfully threw out all the old rules for ILP and instituted means testing, DNA testing, and covert VA Office of the Inspector General  surveillance to make sure you really are as severely disabled as you claim to be. You get photographed laughing when you should be crying like Clinton did at that funeral and your goose is cooked, Jack. No ILP for you. You’re not mentally depressed enough and we have the video.

On a more serious note, I was also told that due to the most excellent points I had brought up in my Form 9, Mr. David Boyd, GS-14 ($110,047.00/ year), head of Seattle VR&E was (or had already) forwarded it to the Central Office in Washington, D.C. to allow more erudite minds to contemplate it and it’s implications to Vetkind. Seems this VR&E file is getting pretty well-traveled between Seattle and DC.

VA is gradually turning the IPL program into a former shadow of itself. Gone are the days of a snowplow attachment to go with your ILP tractor. Riding lawnmower? Shoot, bubba. You need to shag 40 lbs. Get out the push mower. You may even heal up from the DM2 if you loose 80. Reading through the BVA decisions in 2013, hardly anything came up. Vets are getting the message and not even applying. Why bother when the answer is pre-printed, pre-addressed and a foregone conclusion?

The good fellow gave me no idea when it might surface again but after four years, it almost has to be one of the oldest claims on the MMWR.

Enough of that. Look at Spring in the Northwest. Shoot, sounds like an advertisement for Salem cigarettes. Remember, you can click on any of these for a closeup. I pay extra for that.

Strawberries

Strawberries

Strawberries X 10 to the 10,000th power

Strawberries X 10 to the 10,000th power

green pears

green pears

Future Fujis

Future Fujis

Italian Plums

Italian Plums

Soon to Bing Cherries

Soon to Bing Cherries

Red Pears

Red Pears

Gravensteins

Gravensteins

The orchard

The orchard

The not so ILP Greenhouse

The not so ILP Greenhouse

1st Floor- Basil, sugar snaps, kohl rabi

1st Floor- Basil, sugar snaps, kohl rabi

2014 flavors Cupcake chose.

2014 flavors Cupcake chose.

Cuke world

Cuke world

Beets in VA-defined "greenhouse" with latest global warming methane  heating system

2014 Beets in VA-defined “greenhouse” with latest CO global warming methane heating system

 

Posted in Food for the soul, Independent Living Program, VAOIG Watchdogs | Tagged , , , , , , , , , , , , , , | 6 Comments

2014 Hep C Sovaldi sticker shock for insurers

The Kaiser Family Foundation (KKF) has published several articles of interest to Asknod members.  

One April 14 headline reads:  Biggest Insurer Shocked with Hepatitis C Costs.  

Quote: “United Health Group spent $100 million on hepatitis c drugs in the first three months of the year, much more than expected, the company said Thursday.” 

Uh-oh.  High demand and 80K plus per patient in costs have insurers stock costs dropping.   Well, they’ve tried to keep the lid on this disease for decades and now it’s off. 

cat

If only we could have covered up and ignored HCV a little longer…

KKF links to this VA March 27, 2014 38-page document for providers.  It details a “preferred treatment approach” for HCV by genotyping and other factors for “patient selection.”  It’s clear that VA hepatologists  and experts have been working hard on this strategy to deal with all the newly diagnosed veterans.  They have lots of studies and rationales to back up who gets what and when to manage their HCV crisis.

This article,VA, California panels urge costly drugs for sickest Patients, links to the new WHO 124-page  (April 2014):Guidelines for the screening, care and treatment of persons with hepatitis C infection

Unless the cost of the new drugs are drastically reduced, widespread rationing can be expected.  HCV patients will be stigmatized further as undeserving greedy people who…

  • dare seek a cure at the expense of the innovative drug researchers (who deserve their high-living wages for staying up all night in the lab), and
  • keep our altruistic health insurance CEOs up at night with worry, and
  • who torment the generous House members who fund the VHA’s budget.  By golly, we won’t let HCV-veterans defeat our great nation by breaking the bank! 

This is going to be hard for veterans who suffer from the largest cluster of HCV-infections deniedin America by far, because the VHA does not currently have the funds available to treat everyone, other government programs may not be much better off, and private insurers are beginning to panic.  I suspect that patients, including veterans, co-infected with HIV/HCV, will be more likely to get the new antivirals because of existing public policies. But what about the majority who may find themselves with nowhere to turn?

 

 

Posted in Guest authors, Sofosbuvir | Tagged , , , , , , , , , , , , , , , , , | 8 Comments

CAVC–MURPHY V. SHINSEKI-MURPHY’S LAW STILL REIGNS

imagesI often wonder if the original Mr. Murphy ever considered his future enshrinement in the Hall of Giants when he began compiling his laws. I wonder if there was one that covered this sorry mess. Some of us struggle to shepherd our claims intact to a sane judge in DC to render judgement.  Encountering stupidity of the following magnitude would be the absolute last thing we would expect. Having the Murphy sobriquet must have been the trigger. Either that or one of the good Veterans Law Judge’s staff attorneys has a macabre sense of humor.

Murphy_12-1700

download (2)George D. Murphy enlisted in the Air Force (wisely ) and pursued a thirty-year career. When he separated, he filed for sinusitis and was issued a 10% rating in 1984. Sixteen years later, he petitioned for an increase and was denied. As do most of us, he failed to appeal and that went down the tubes.  In 2003, he refiled yet again, probably after reading up on the procedures on how this all worked. He was Air Force and they are picky about your being able to read and comprehend. As usual, he got the typical denial and a long wait while they prayed he’d get bored and walk away. This time was different. George wasn’t going to listen to the VSO tuki tuki bird.

Even with no big VA backlog, his claim slowly wended it’s way to the Board of Veterans Appeals for four years. He got his five minutes with the Judge in February 2010. After all that interminable delay, the BVA promptly remanded it for a new C&P exam to find out what had transpired in the intervening seven years while the claim grew dust. Such is the pace of VA justice that when you finally get your day in Court, your claim has to be sent out for a reassessment because you aged so much in the interim. It’s also pretty scarey when nobody, including VA, thinks much of it when Vets have to wait that long.

At the VA, if you have signed a waiver of review in the first instance of any new evidence presented, the Board’s very own private Regional Office called the Appeals Management Center (AMC) is authorized to do all this and make a decision without remanding it all the way back to your own RO for a new decision at the local level. This was supposed to be a time saver when instituted in 2004. It has now devolved into a miasma of remands for all manner of problems and is sometimes no faster that just remanding back to your own RO. Vets have even nicknamed it the Black Hole. I still think they are a step above local ROs. They don’t have Binford 5000 Shredomatics installed desk-side so your evidence actually does make it into the file. The quality of the raters is above par, too. The last thing you want is a Gomer Pyle FNG doing it.

Mr. Murphy’s remand disappeared into the Black Hole but in six short months he got his 30% rating. This was a watershed moment as it now added to his rating total to attain 100% combined and a hefty pay raise. Most Vets don’t know it but VA pay is $1,857.76 per month for 90% with spouse and without rug rats. 100% is $3,017.60 – an almost $1,110.00 + difference monthly. Annually, that’s a pay raise of over $12,000.00. And here is where our Mr. Murphy ran afoul of his namesake’s Laws.

An old decision called AB v. Brown  6 Vet. App. 35 (1993) held that a Veteran who appealed for a higher rating was appealing for the highest rating attainable and not just the one above the current one he was being compensated for. The reason they used the initials AB is that the claimant wished to maintain anonymity- perhaps because the disease or injury was to a private part or the clap. The CAVC is tasked with making the determination as to whether the request is granted. Not all are. Thus Mr. Murphy’s claim was required to be sent back up to the same Veterans Law Judge who remanded it for a determination as to whether the increase from 10% to 30% might not be premature. In fact, Mr. Murphy was entitled to an appellate determination, under the auspices of AB v. Brown, as to whether he might be entitled to 50% (or higher). But under no circumstances could the VLJ lower the rating. Shoot, that’s against the law in all 57 ROs including the Black Hole. 

AB.211

We are protected against this injustice by many statutes and regulations. Once we get a rating, we own it. After five years with no appreciable improvement, VA needs dynamite medical evidence to dislodge it. Under no circumstances, can a VLJ start disassembling it at the BVA level. They’d have to remand yet again to have the RO or the Black Hole execute that dirty deed. Besides, by law, you have to have a medical exam or two to reduce a rating and be given sixty days to respond to this injustice following notification. In fact, the list of judicial faux pas runs into eight pages or more.

Finally, under the due process holding of Cushman v. Shinseki, we have a vested right in our compensation payment. Any decision to rescind or abrogate that must be based on fraud, clear and unmistakable evidence to the contrary and a denial in the first instance down at the Regional Office level such that you could appeal it upwards properly. If the BVA started doing this on a regular basis, you’d be unable to combat it or even rebut it with new and material evidence when it arrived at the Court.

You can see what this looked like when it came through the mailroom at 625 Indian Ave. NW. The chief Law Clerk up there, Gregory Block, is an old Army war horse. As would be expected, everyone around there is sporting a JD after their name- even the janitors. His is from Seton Hall and certainly one held in high regard. It can probably be said that the Gregster was alerted in short order when Mr. Murphy’s NOA crossed the threshold. This was a golden opportunity to make the BVA, and by extension, the whole VA leagal beagle kennel, look like rank amateurs. By allowing this out the door of the BVA without more scrutiny and oversight, they were advertizing the bona fides of their inferior Juris Doctor degrees for all to see. Appearance is everything in this business. If you look like a boob and act like one, you’ll get laughed right out of the court. No one will treat you seriously. Your legal theories will be ridiculed from then on even if  they are sound. Your credibility will be so compromised that you’ll even lose your own kids’ respect. You might as well advertize your membership in the Flat Earth Society.

Let me put it in perspective. Each level of jurisprudence considers itself more erudite, more educated, more highly paid and lastly, mo’ better than the traffic cops beneath it. As your claim rises to each new level of review, it is supposedly vetted for proper judicial procedures to make sure you, the claimant, were not disenfranchised. Translated into DickandJanespeak, VA likes to make sure they screwed you over perfectly legally (in their own mind) before turning it over to the CAVC on appeal.

As the CAVC is not part and parcel of the VA proper, they are not swayed by VA’s desire to cover up their errors and stupidity. Some colossally big ones like Leroy Macklem’s sometimes get out of the Pandora Box at Vermont Ave. NW but VA strives to conceal them via Joint Motions for Remand (JMR) to quietly whisk them under the carpet.

Mr. Murphy’s case gets the front stage, three Judge Panel treatment because his Veterans Law Judge illegally attempted to play Judge, Jury and Executioner over something he had no legal authority to address. However much his distaste for the AMC’s decision to grant George 30% for nose itch, the VLJ cannot summarily reduce it on his own. This is mission creep in CAVC parlance and Greg the Bouncer spotted it for what it was from the getgo. And like a dog with a bone, once apprised of the enormity of the BVA’s lack of legal talent, they weren’t going to let this one go until every VA Law Review magazine had all the juicy details.

110For that reason alone, cases like this get the reversal treatment. The CAVC Judges are not vindictive but when you cross that line from sloppy jurisprudence into judicial mis/malfeasance you can be confident of being brought back down to earth with a rough, caustic verbal tackle. As usual, Meg Bartley got the author honors on this one. Seems she’s been the author or Single Judge decision maker on quite a few reversals in her short tenure at the Court. It’s so refreshing to see someone who set precedence with their mere presence and interpretation of law while in charge of the NSVLP’s Veterans Benefits Manual authorship finally doing so from the bench.

We look forward to more of the same. Every Veteran should hire a soothsayer and tea leaf reader to find the most auspicious time to file their Notice of Appeal in hopes of drawing St. Meghan. If you have a valid claim, your chances of bringing it to fruition skyrocket in her courtroom.

Posted in CAVC ruling, CAVC/COVA Decision | Tagged , , , , , , , , , , , , | 3 Comments

WHO SAYS SEXTING AND DUIs REDUCE WORK PRODUCTIVITY?

downloadWe always read horror stories about the VA and government in general. Tip of the Spear in Georgia (Bruce) who brought us the initial reports of “irregularities” in a Veterans charity’s wage structure, sends us this equally revolting report on VA’s proclivity to “Fire the Best and Hire the Rest (if they’re related to you). 

 

It completely defies logic to have an agency tasked with such an important task take such a lackadaisical approach to our plight. I don’t like to whine. I like to strike, to take action- in a word-to improve the status quo at lightspeed.  Unfortunately, VA doesn’t have a lightspeed setting. VA hierarchy has no qualms about allowing this system to rot on the vine just as they have no plan to fix their backlog. Some have contacted me and tell me I’m wet and don’t get out much. They probably haven’t spent a year as a guest in a VAMC and witnessed ODing on Heparin, a MRSA infection via their PICC line or a septal infarct that went undetected for six months. I forgot to check but I’m sure the VISN director for the Seattle VAMC received a large bonus while on my watch. According to this article, that’s par for the course and not some aberration.

To really get a feel for this, read the plethora of  follow-on comments from actual VA employees (present and former) who do not seem particularly perturbed by this turn of events. We are handed a rotten deal from the get go. We are pawned off on an overwhelmed system staffed by incompetents who have no loyalty to Vets. We are assured we’ll get quality care “soon”. We are lied to, delayed and ignored by a medical system that insists it is cutting edge. To add insult to injury, they find “satisfied customers” to spout their propaganda on their blogspot Vantage Point. I have railed on and on here about their shortcomings and been told by some of you that I must be one of the most unlucky souls to ever darken the door of a VAMC.  One gentleman implied that my complaining would make life worse for other Vets and I should shut up and sit down. This article in no small measure vindicates what I’ve been trying to get across for years.

VA has proven time and time again that they will only jump when they find themselves between a judicial rock and a hard place. One brief glimpse of the Extraordinary Writs filings at the CAVC would reinforce this thinking. Many are the filings of Vets who simply want some closure to an ages-old claim that is stuck in limbo somewhere. When the Court queries the VA secretary and his minions, suddenly it is resolved. The logjam miraculously dissolves and what was sought is found to have been accomplished while the thirty-day-old complaint was still in the Court’s in-basket. A coincidence you say? I think not.

VA is intransigent. Mark my words now. They have no plans for the “what if” moment on January 01, 2015 when the backlog will still be firmly entrenched and alive and well. I see a plethora of excuses queueing up waiting to be employed though. VA medical procedures and indeed, even their personnel problems, will never subside without a sharp prod from Congress. I don’t see that happening any time soon-if ever. Of course, complaining mightily about it will do no good either.

Unless, and until Congress elects to actually punish individuals who perpetuate this system, there is no force on Earth that can overcome the impasse. The VA is far too busy creating new acronyms and programs to deal with every imaginary threat to their viability at our expense. Each new program takes us further and further away from the core function-the Veteran. As an example, look at gun laws. Every new atrocity spawns a new batch of laws designed to prevent such an event from reoccurring. No one looks back over the laws already promulgated and on the books to notice that many of these eventualities have all been provided for. In what many have touted as a perfectly controlled setting, the impossibility of having an “adverse gun event” on a military installation has been examined in detail and every eventuality accounted for. Yet somehow it still occurs in a designated gun-free zone. VA takes this to the logical end and provides for every contingincy. When something like a mass outbreak of Hepatitis C occurs at the Dayton VAMC due to unsanitary procedures, VA’s Office of the Inspector General descends in force and examines it in minute detail. Their findings often include the phrases ” We wee unable to substantiate that the_____ were incompetent” or “It was not conclusively proven that the individuals in charge were criminally negligent.”  The mea culpas are not far behind in the Recommendations section.

VA has an enormous, magnificent excuse machine built into the system. Were you to read the whitewash about the multimillion dollar HR getaways in Orlando in years past, you would come away with glad heart and the conviction that this egregious behaviour will never, ever happen again.

vaoigEvery month I get the VA news feed from the OIG. Each and every one reads like its predecessor. The recommendations section is mimeographed from prior ones. Every few months a new set of recommendations surfaces based on a large number of complaints of new, previously undiscovered travesties. The years and recommendations tend to blur together because they all boil down to recommendations and not change orders. You can recommend to an alcoholic that he should cut back on his consumption if he wishes to improve his lot in life but absent any intervention it is merely good advice with no teeth.

Notice the similarity of “findings” in each of these. Pressure ulcer prevention (bedsores) seems to be the bugaboo this year so far. Well, that and “community living center resident independence and dignity”. I suppose that means the staff can no longer tell the inpatients to piss off.

http://www.va.gov/oig/publications/report-summary.asp?id=3077

http://www.va.gov/oig/publications/report-summary.asp?id=3076

http://www.va.gov/oig/publications/report-summary.asp?id=3074

http://www.va.gov/oig/publications/report-summary.asp?id=3068

http://www.va.gov/oig/publications/report-summary.asp?id=3068

The term “lather, rinse and repeat” rolls of the VA OIG’s tongue with alacrity and great frequency. How they can just reprint the same litany of excuses and expect our eyes to glaze over with boredom is amazing. I expect they think no one reads these epistles.

Reform at the VA is similarly stymied by lots of recommendations and four-letter programs that seek to focus on the problem-du-jour. Unfortunately, the calamities at the VA are so continual and so grievous, no amount of triage can keep up with the ineptness. As an example, did you know the VBMS system set up to electronically revamp our records is still not operational system -wide in all  VAROs?  After two or three years the excuses wear thin. Not enough servers. Too many RVSRs online simultaneously. Pick any excuse and then parse it for legitimacy.  Someone once opined that excuses are most definitely like assholes. Everyone has one, but for some inexplicable reason. VA medically defies logic and has numerous assholes whose primary job is none other than to obfuscate and apologize. If half the energy expended to manufacture excuses were devoted to claims adjudication, it is highly unlikely we’d be in the predicament we’re in now.

Here’s a sampling of some Extreme Writs I’ve parsed recently from the Court. Each one exhibits the same hubris that the VA was always in the loop and the Vet is simply expecting far too much too soon from the system (which, incidentally, is working just fine).

In his petition, he asks the Court to order the regional office (RO) to produce a copy of his claims file. The petitioner states that he mailed his first request on March 18, 2013, and that the RO has only responded that it received his Freedom of Information Act (FOIA) request…

Or

The petitioner contends that a prior remand of his claim by this Court in May 2012 for compliance with VA’s duty to assist has resulted in inaction by VA and “interminable delay”  notwithstanding this Court’s directive to act within six months. 

Followed by the revelation from the VA’s OGC excuse squad…

On January 22, 2014, counsel for the Secretary responded that she contacted the Indianapolis, Indiana, VA regional office (RO) and was informed that all documents from the service department were received, including the charge sheet pertaining to the petitioner, and that a Supplemental Statement of the Case (SSOC) was issued on January 15, 2014. 

or…

On December 3, 2013, the petitioner, Claude V. D’Unger, submitted through counsel a petition for extraordinary relief in the nature of a writ of mandamus ordering VA to forward his file
to the Board of Veterans’ Appeals (Board) for action on his claim…In April 2009 his rating was increased to 100% with an effective date of March 2009…

According to VA, the petitioner’s claim remains before the regional office (RO) pending adjudication by the RO. The Secretary asserts that the RO cannot adjudicate the claim without
additional development, consisting of a new medical examination. In his response, the Secretary informed the Court that an examination had been requested through the VA medical system on January 23, 2014…

The delay here in completing the Board’s remand does not satisfy these conditions. The Court recognizes that this claim is unresolved at four years and counting, but a writ is not justified
at the present time because VA is taking action to adjudicate the claim. The RO has just now requested an examination. With VA alert to the delays in Mr. D’Unger’s case and taking steps to comply with the Board’s remand, a writ ordering VA action would be unjustified and, hopefully, redundant…

I could go on but the reader can ascertain the essence of the problem. Running from one brush fire to another with a hand-held fire extinguisher is no substitute for a system-wide revamp of the process. VA is disinclined to purchase a bonafide fire truck and prefers to myopically address each calamity on a case-by-case basis.

downloadUntil this myopic, neanderthal thinking process is upgraded to the twenty first century, we will be condemned to more of the same. It’s not getting better in spite of what the talking heads tell Congress. Apparently Speaker of the House Boehner has now been apprised of the disconnect and it will be repaired soon. We expect to see pigs suitably outfitted with wings down at 810 Yellow Brick Rd. NW any day now.

 

Posted in VA BACKLOG, vA news, VAOIG Watchdogs | Tagged , , , , , , , , , , , | Leave a comment